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Chapter 15.2 - Fetal lung growth, development, and lung fluid

Clinical management of pleural effusion and pulmonary pathology

from Section 2 - Fetal disease

Published online by Cambridge University Press:  05 February 2013

By
Kirsten Grabowska  and
R. Douglas Wilson
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
Mark D. Kilby
Affiliation:
Department of Fetal Medicine, University of Birmingham
Anthony Johnson
Affiliation:
Baylor College of Medicine, Texas
Dick Oepkes
Affiliation:
Department of Obstetrics, Leiden University Medical Center
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Summary

Introduction

Primary fetal lung and airway anomalies are rare. With improvements in ultrasound, our understanding of both the underlying pathology and natural history has improved over the past two decades. With the improved surveillance and advances in fetal therapy, there have been significant improvements in perinatal survival. The following section presents a review of the most common pulmonary pathologies, including fetal pleural effusions (FPE), pulmonary adenomatoid malformations, and CHAOS (congenital high airway obstruction sequence). The antenatal management, with particular focus on prognostic features and indications for intervention, is described. The evidence-based methods of fetal therapy, and available data on fetal and neonatal outcome following antenatal intervention are reviewed.

Incidence, etiology, associated features, and natural history

FPE is a condition with identified fluid collections in the pleural spaces of the fetal thorax. Primary FPE (chylothorax) is the accumulation of lymphatic fluid in the pleural space. Secondary FPE result from the collection of serous fluid in the pleural cavity. Secondary FPE can be caused by congenital infection, aneuploidy, and congenital defects, including cardiac defects, pulmonary adenomatoid malformations, and congenital diaphragmatic hernia (CDH). In fetal hydrops due to severe anemia, FPE is rarely seen.

Keywords

pulmonary adenomatoid malformationscongenital pulmonary airway malformationfetal pleural effusionsfetal therapycongenital high airway obstruction sequencebronchopulmonary sequestrationcongenital cystic adenomatoid malformations
Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 282 - 300
Publisher: Cambridge University Press
Print publication year: 2012

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